Injured workers’ insurance fund

Request for Information on Investment Management Services

A: CONTACT INFORMATION

Completed by: ______Title: ______

Telephone: ______Fax: ______Email: ______

Date Completed: ______

Other contact: ______Title: ______

Telephone: ______Fax: ______Email: ______

Firm Name: ______

Main Address: ______Suite ___ City:

State:______Zip:

Main Telephone: ______Main Fax: ______Email: ______

Firm Website: ______

B: ORGANIZATION

Firm History: (one paragraph)

______

______

______

______

Year Founded:

Type of Firm: ______

Ownership structure, please describe in detail including any outside ownership and relationship, if any, to the firm.

______

Percentage Active Employee Owned: %

African American: % Native American: %

Asian American: % Women: %

Hispanic American: % Other: %

Other business relationships (i.e. Joint ventures, broker-dealers, WRAP, mutual funds, hedge funds and/or any subadvisory relationships). Please list and include detail regarding any financial services businesses, outside of the firm, in which the investment staff or owners may be involved, if applicable.

Locations of other offices? ______

If so, where are investment decisions made? ______

Organizational changes planned for the next 12 months?

______

Current capacity constraint (in terms of assets) – please discuss for each product/style and overall firm assets. ______

Growth objectives (long-term growth of assets) either in terms of the dollars managed or the number of accounts? ______

Objectives are achieved (include additional staffing requirements) by:

______

Marketing/client service function – please include a description of this function [e.g., in-house sales and marketing staff, 3rd party marketing agent (list, if applicable), word of mouth]______

______

Written business plan in place? If so, describe whether the execution of this plan is in line with your expectations. ______

Administrative management – who is directly responsible (or takes the most active role)?

______

Succession / contingency plan for a loss of key decision-makers (please describe):

______

Systems used for:

Investment Research ______

Portfolio Accounting

Trading ______

Other

C: Assets under management

Total Assets Under Management: As of Date:______

Assets under management threshold required to break even? ______

Average account size:

Largest account: $ ______

Product Type (please provide a breakdown):

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Product Name Product Style* Product AUM Inception Date

______

* e.g.: Domestic Fixed Income Core

Client Type – provide a breakdown by dollar amount and number of accounts:

# of accounts

Institutional $ ______

Individual/High Net Worth ______

Mutual Fund ______

Sub Advisory Relationships ______

Hedge Fund ______

Other (Explain client type) ______

Total $ ______

Three largest institutional accounts (list name, amount and strategy). If you cannot list the name due to a confidentiality agreement, please list the client classification (ie – public pensions plan, corporate pension plan, foundation, etc.)

Name Amount ($) Strategy

Client Turnover: Assets/accounts gained/(lost) for current year and past 5 years

(also include Assets/accounts under management and number of employees at each yearend)

Year / AUM @
Yearend
$(mil) / Assets
Gained / Assets
Lost / Total
Accounts
@ Yearend / #Institutional
Accounts
Gained / #Institutional
Accounts
Lost / # of
Employees
@Yearend
2012
2011
2010
2009
2008
2007

Account turnover – please include an explanation for any unusual circumstances associated with the above accounts. ______

______

Fee Schedule – please provide for each of your products/styles that are geared toward institutional investors.

Products / Styles / $(mm) / Fee %

D: Personnel

Total # of Employees:

Total # Equity Fixed

Portfolio Managers:

Portfolio Administration:

Analysts/Researchers:

Traders:

Client Service/Marketing:

Risk Management:

Compliance Officer:

Systems / Information Technology:

Other:

Product Portfolio Manager or Team Members Dates (from-to)

______

______

Please provide biographies for all key investment professionals listed above.

Portfolio Manager and Analyst – please provide the following for each (refer to Biographies):

  1. Years of portfolio management experience (PM only):
  2. Years of research experience:
  3. Sector/industry covered:
  4. Years of coverage experience for each specific sector/industry.

How long has the investment staff worked together as a team? (Please provide detail)

______

Investment personnel turnover in the last five years? Please provide job functions (e.g. “1 Analyst”).

Job

Additions Terminations Resignations Function

2012

2011

2010

2009

2008

Total

Terminations – please include an explanation for any listed above. ______

______

Disciplinary action – has any such action been taken by the firm with respect to any employee who is in a position of fiduciary responsibility or senior management (Yes/No)? If “Yes”, please explain. ______

Compensation system – please describe for key investment management professionals, including research analysts. ______

______

Alignment of interests – to what extent does the principals and employees have their own assets invested in firm products, alongside clients? ______

______

Code of Ethics – Does your firm have a Code of Ethics for Employees to ensure clients’ interests are protected (Yes/No)? If so, please attach.

E: Decision Making Process and Investment Style

Investment Policy – please provide a description of such for each product or distinct investment style offered by your firm.

Investment Strategy – please provide a brief description of such for each service or distinct investment style offered by your firm.

Source for generating new investment ideas?

Internal %

External %

Sources of research?

Internal %

Street %

Other (list) ______%

Research process – please discuss: ______

______

Portfolio construction and decision-making process – please provide a description of said process for each service or distinct investment style offered by your firm (separately).

______

Please identify the individuals responsible for the investment decision-making process for each product. ______

Biases – describe if your portfolio has any biases with regard to specific sectors, industries or market capitalization?______Are there sectors in which your firm does not typically invest? ______

Risk Management – please discuss

______

Timing – what role, if any, does it play in your process?______

Sell Discipline (profit taking and risk control) – please provide a description of said discipline employed for each distinct style. ______

What is the expected annual portfolio turnover? ______

Documentation of investment decisions – how does your firm maintain such documentation, including a price target and investment target? ______

______

Attribution analysis – please provide a detailed description of the use of said analysis in reviewing investment performance and investment decisions and, when necessary, making process improvements. ______

______

Time allocation?

a.  Screening and identifying new ideas: %

b.  Quantitative analysis:

c.  Fundamental research:

d.  Portfolio construction:

Investment Process:

Please list to what extent each style adds value to the overall management of the portfolio:

Credit Quality (%):
Duration Management (%):
Industry/Sector Allocation (%):
Security Selection (%):
Yield Curve Management (%):
Other (%):
Total (%): / 100%

Distinct style approach – what distinguishes your firm’s style approach from other firms investing in each of the particular segments of the market? ______

______

Portfolio decision making:

How are decisions made to add a security to the portfolio?______

Does any one person dominate the decision-making process?______

Performance excels in what types of markets? ______

Performance lags in what types of markets? ______

09/30/12 / 12/31/11 / 12/31/10 / 12/31/09 / 12/31/08 / 12/31/07
Portfolio Characteristics:
Yield to Maturity
Average Quality
Effective Duration
Average Coupon
Portfolio Quality:
% in AAA bonds
% in AA bonds
% in A bonds
% in BBB bonds
% below Investment Grade
09/30/12 / 12/31/11 / 12/31/10 / 12/31/09 / 12/31/08 / 12/31/07
Portfolio Sector Exposure (%):
U.S. Treasuries
U.S. Agencies
MBS
ABS
U.S. Investment Grade
Corporates
U.S. High Yield
CMBS
Municipals
Cash
Emerging Market Debt
Non-Dollar Sovereign
Non-Dollar Corporates:

F. Performance

Please provide the following general characteristics for each product or distinct investment style offered.

Fixed Income Product:

Current Portfolio Manager

Start Date:

Benchmark Index:

Assets in This Style:

Duration:

Moody’s Quality Rating:

Yield to Maturity:

Max. Cash Position (%):

Number of Positions:

Max. Weighting per Positions (%):

Annual Turnover:

Percentage of Assets in Composite

Portfolio:

Performance Composite:

GIPS Compliant:
Has the Composite been Certified?
Name of Certification Firm:

What is the strategy’s target return (in terms of bps above the appropriate Russell Style Benchmark)? ______

What is the strategy’s target risk level (in terms of tracking error vs. the appropriate Russell Style Benchmark)?______

What is the dispersion of returns for each composite? Number of accounts performing better ______/ worse______than the composite performance?

Do you consider this dispersion:

None Low Moderate High

Please provide an explanation if spread is moderate to high.

______

Monthly and quarterly performance information – please provide (gross of fees) for the most recent five years for each investment style. If available, please provide in MS Excel format.

Performance numbers are from:

Composite Selected Accounts Simulation/Model Other

If other, please explain:

______

Performance information is reported

Gross of fees Net

Which peer universe do you use to benchmark your performance? ______

Are these numbers prepared in accordance with CFA Institute Standards? Yes No

If not, at what level, if any, does the firm comply? ______

Have the numbers for the most recent year-end been formally audited? Yes No If so, by whom? ______

Please list any other products/strategies not included above and the assets under management in each (please include mutual funds, subadvisory relationships, hedge funds, etc.). ______

______

To what data base(s) do you supply performance information?

Nelson’s Mobius Other______

G: Insurance and Compliance

Insurance – list names of carriers and the dollar amount of coverage and deductible.

Errors & Omissions: ______$ ______

Fiduciary Liability: ______$ ______

Disaster Recovery – what procedures are in place?

______

Compliant with SEC, DOL and any other applicable regulatory agency?

Yes (please provide a copy of compliance) No

If No, please explain.

Compliance monitoring – how is it done with respect to both internal investment guidelines and client guidelines? ______

Who is responsible for this function? ______

Dedicated compliance officer? If not, who is responsible, and what other duties, if any, are performed by this individual?

Current or past investigation, litigation or administrative proceedings against your firm or its officers, directors or employees in connection with services rendered by them on behalf of the firm? Yes No

If “Yes,” please describe the nature of the pending litigation or administrative proceedings. ______

H: Additional Comments and Information

How did you hear out about IWIF?

Has your firm previously met with the IWIF Investment Dept.? Yes No

If so, when and where? ______

Please include: Brochure and marketing material

Sample Portfolio (Ticker/# shares)

Current Form ADV (Parts I & II) and the date it was last updated.

References: Please provide the name (and contact information) of at least two client and former client references.

Please provide any additional comments that may be helpful in understanding your firm.

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